For the Mentally Ill, It’s Worse

Last week, one of the landmark nonfiction books of the last 50 years was reissued by Vintage Books. “Is There No Place on Earth for Me?” by Susan Sheehan began in 1981 as a four-part series in The New Yorker; in 1982, it came out as a book, winning the Pulitzer Prize.

“Is There No Place on Earth for Me?” is about a woman who suffers from severe schizophrenia. In the book, Sheehan calls her “Sylvia Frumkin,” a pseudonym meant to protect her privacy; her real name was Maxine Mason, which Sheehan divulged after Mason died, at the age of 46, in 1994. She was overweight and overbearing, a difficult person even in the best of times, but also, Sheehan told me recently, “bright and articulate” — when she wasn’t delusional. The book’s title was a question Mason “had first asked her mother in an ambulance transporting her from one hospital to another in 1964,” as Sheehan wrote in an essay published after Mason’s death. (It is included as a postscript to the new edition.) Mason was 16 at the time.

I have no idea what moved Vintage Books to republish “Is There No Place on Earth for Me?” but I’m glad it did. The story Sheehan tells is a terribly sad one, and not just because of the flashes Mason shows of what she might have become if she had not suffered from mental illness. It is also appalling to see what she goes through as a mental patient: the hospitals that overmedicate; the misdiagnoses by doctors after the briefest of examinations; the lack of any kind of safety net when she is not hospitalized. But here’s the worst part: Even though the story Sheehan tells is more than 30 years old, there is only one real difference between then and now for the mentally ill. It’s worse today.

The deinstitutionalization movement was well underway when Sheehan was doing her reporting. In the 1960s, during the Kennedy and Johnson administrations, the federal government passed a series of laws designed to liberate the mentally ill from the acknowledged horrors of mental hospitals, where they were often confined for decades. The idea was that with the introduction of powerful new antipsychotic drugs, people with schizophrenia could live outside a mental hospital — and that hospital stays would be much shorter. The federal government gave money to communities to set up local mental health centers as well as housing for the mentally ill.

In 1975, this trend was affirmed by the Supreme Court, which ruled that the mentally ill had a right “to live in the least restrictive setting necessary for their well-being,” as Sheehan writes. By the time Sheehan met Mason, in 1978, the average stay at Creedmoor — the New York psychiatric hospital where much of the book takes place — was 38 days. Some 67 percent of the admissions were people who had had previous stays at Creedmoor.

On the one hand, many mentally ill people were able to lead fuller, richer lives thanks to the deinstitutionalization movement. But as Sheehan’s book illustrates, there were also many people for whom the drugs did not have a pronounced effect — or who stopped taking the drugs as soon as they left the hospital. Yet there were no longer enough hospital beds for them, hence the need for hospitals to drug them up and move them out.

E. Fuller Torrey, perhaps the most vocal critic of the current mental health system, says that before deinstitutionalization there were 312 public psychiatric beds for every 100,000 people. That was clearly too many. But today there are a paltry 14 beds for every 100,000. Torrey estimates that we need at least 50 beds per 100,000.

Meanwhile, what happened to patients once they left the hospital was often horrendous. State mental hospitals would release patients with little idea where they were going. They often ended up on the streets, or in prison, which have become today’s de facto mental hospitals.

In one sense, Maxine Mason was lucky. Though she had enormous difficulties with her parents, they clearly loved her and tried, as best they could, to help her. Her sister Trudy did the same after her parents had died, pulling strings to get her into the kind of outpatient housing that was envisioned when the deinstitutionalization movement began. The problem was that Mason was simply too sick to last long in such an environment. She needed to be in a hospital — a humane hospital where she could get the care she needed. It never happened.

I remember thinking when Sheehan’s articles first came out in The New Yorker that someday we would look back in horror at the way our society treated the mentally ill. Thirty three years later, that day still hasn’t come. But it will.